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by such writers as André Breton, Thomas Mann, and Arthur Koestler, and by surrealist painters, became a fad among the intelligentsia; undergoing analysis was almost a rite of passage for the avant-garde. Psychoanalytic ideas were also reaching millions of ordinary folk; Dr. Benjamin Spock’s Book of Baby and Child Care, which advocated child-rearing practices based on Freudian views of human development, sold over twenty-four million copies between the late 1940s and 1970s and was the most important single vehicle by which Freudian psychology influenced American society.22 Unfortunately, psychoanalytic ideas were often distorted by enthusiasts who used them as license to blame their failures on their parents. As Erik Erikson ruefully said, “Even as we were trying to devise a therapy for the few, we were led to promote an ethical disease for the many.”

The impact of psychoanalysis was extraordinary, considering how few analysts and analysands there were. At the height of its popularity in the mid-1950s, there were only 619 medical analysts and about 500 lay analysts in the country and perhaps a thousand in training in some twenty institutes for physician analysts and a dozen for lay analysts.23 While no census exists of analysands, if most analysts worked eight hours a day and saw each patient four or five times a week, the total number in treatment at any time could have been only about nine or ten thousand, an insignificant fraction of all those with mental disorders. Nor could the relatively few psychoanalysts who specialized in treating children handle more than the select few with rich parents. A case report in The Psychoanalytic Study of the Child in 1949 concerned a five-year-old boy who was afraid to be in school without his mother and who was cured by a psychoanalysis that lasted three years. (The analyst never considered, and perhaps did not know of, any briefer way to treat the boy’s phobia.)24

The cost, time required, and disruption of daily life caused by regular appointments were bound to prevent the therapy from becoming widely used. But there were other obstacles. The cognoscenti soon learned, and made sport of the fact, that it often seemed a swindle, with the patient spending money, time, and effort while the psychoanalyst did and said almost nothing. Classically trained Freudians, who still constituted the great majority of psychoanalysts, had become more distant and unapproachable than Freud had ever been. (Freud once said, “I am not a Freudian.”25) Many spoke very little but simply listened to their patients, fending off questions about what they thought of the patient’s narrations or symptoms with evasions like “Why does that seem important to you?” and “Why do you think I would feel that way?”

The rationale was (and still is) that the analyst’s expressions of thought and feeling would make him or her a real person instead of a vague figure and thereby interfere with the patient’s transference—projection onto the therapist of an important figure from the patient’s childhood. Such transference was, as it remains for many analytic practitioners, an essential mechanism in the curative process. But even the most rigid analyst had to communicate now and then. Psychoanalytic training stressed that changes were produced by making the unconscious conscious through free association and through three processes requiring the analyst to speak (though not about his or her personal feelings): the interpretations of dreams, of transference, and of resistance.26

But though analysts did talk from time to time, many patients were aware chiefly of their silences and refusals to answer questions, and were infuriated—but unable to break away. One analyst wrote of treating an attractive young woman “who bawls me out unmercifully almost every hour, calling me immature, a quack, cold, a sex maniac, and so on, yet at the end of the hour she gives me a deep, longing look and says softly, ‘See you next time.’ ”27 In The International Journal of Psycho-Analysis another reported the following diatribe (here somewhat abridged)